From the Guidelines
The life expectancy for a 75-year-old male with primary high-grade B-cell lymphoma of the bowel with metastatic disease, including a partially obstructing tumor in the terminal ileum, who is declining curative chemotherapy, is likely measured in weeks to a few months. Without disease-directed therapy, patients with high-grade lymphomas typically survive between 1-3 months, though individual cases vary 1. This patient's complications of GI bleeding, blood loss anemia, pain requiring opioids, and need for NG tube decompression suggest advanced disease with significant symptom burden, which generally portends a poorer prognosis.
Palliative Care Considerations
Palliative care would focus on symptom management including:
- Pain control with appropriate opioid regimens (such as morphine 5-15mg every 4 hours or equivalent)
- Management of bowel obstruction symptoms (potentially with octreotide 100-600 mcg/day subcutaneously to reduce secretions) 1
- Consideration of palliative radiation to the obstructing mass if appropriate
- Blood transfusions might provide temporary relief from anemia symptoms
Prognosis and Survival
The aggressive nature of high-grade B-cell lymphomas, combined with the patient's advanced age and decision to forgo curative treatment, significantly limits survival expectations, though some patients may occasionally survive longer with good supportive care. According to the most recent guidelines, for patients with a life expectancy of months to weeks, the focus should be on managing symptoms and improving quality of life, rather than pursuing curative treatments 1.
Key Recommendations
- Palliative care should be prioritized to manage symptoms and improve quality of life
- Consideration of pharmacologic measures, such as opioids, antiemetics, and corticosteroids, to manage symptoms
- Potential use of somatostatin analogs (e.g., octreotide) to reduce secretions and manage bowel obstruction symptoms
- Discussion of surgical risks and benefits, as well as alternative management options, with the patient and their family 1
From the Research
Life Expectancy and Palliative Care
- The life expectancy of a 75-year-old male with bowel primary high-grade B-cell lymphoma and metastatic disease, including a partially obstructing tumor in the terminal ileum, cannot be directly determined from the provided studies.
- However, the studies suggest that palliative care can improve the quality of life for patients with advanced disease, including those with cancer 2, 3.
- Palliative care focuses on relieving symptoms, such as pain and dyspnea, and improving the patient's overall comfort and dignity 2, 4.
Symptom Management
- The patient's symptoms, including abdominal pain and distension, can be managed with palliative care approaches, such as opioid therapy for pain management 5, 4.
- The use of opioids for pain management can be effective, but it is essential to address potential barriers, including patient reluctance to report pain and professional barriers, such as inadequate pain assessment and lack of specialist knowledge 5.
- Other symptoms, such as nausea and vomiting, can be managed with targeted therapies, and excessive respiratory secretions can be treated with reassurance and, if necessary, drying of secretions 4.
Goals of Care
- The patient's decision not to pursue curative chemotherapy should be respected, and the focus should shift to palliative care and symptom management 2, 3.
- The goal of care should be to improve the patient's quality of life, alleviate suffering, and provide comfort, rather than pursuing curative treatments 6.
- It is essential to have a clear understanding of the patient's goals and values to provide personalized care and make informed decisions about their treatment 6.